Krystin Jade Provo, D.C

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

01-05533 Issued in KS

Practice address

112 E 17TH St
Ottawa, KS 66067-3800

Phone

(785) 242-9393

Fax

(913) 538-2289

NPI assigned

May 6, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tanner Christensen Chiropractic LLC

  • Chiropractor
  • Ottawa, KS
  • NPI 1841840576
  NPD
• Franz Chiropractic LLC

  • Chiropractor
  • Roeland Park, KS
  • NPI 1205726577
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1598100448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 E 17TH ST",
            "city": "OTTAWA",
            "state": "KS",
            "postal_code": "660673800",
            "telephone_number": "785-242-9393",
            "fax_number": "913-538-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 E 17TH ST",
            "city": "OTTAWA",
            "state": "KS",
            "postal_code": "660673800",
            "telephone_number": "785-242-9393",
            "fax_number": "913-538-2289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVO",
        "first_name": "KRYSTIN",
        "middle_name": "JADE",
        "name_prefix": "Dr.",
        "credential": "D.C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-06",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "KS",
            "license": "01-05533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William G. Pfizenmaier, P.T., A.T.C.
• Lindsay Phillips, PHARMD
• Aaron Pope, PHARMD
• Prairie Flower Counseling LLC (Prairie Flower Counseling)
• Precision Cancer Center LLC (Precision Cancer Care)
• Lucas Queen, 1205262375
• Ransom Memorial Hospital
• Ransom Memorial Hospital (Internal Medicine Associates of Ottawa)
• Ransom Memorial Hospital
• Ransom Memorial Hospital (Ransom Memorial Medical Group)

• Chiropractor in Ottawa, KS
• Providers in Ottawa, KS by specialty
• Chiropractor in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.